Reducing hospital readmissions using a multimodal evidence-based approach

Abstract

Background: Readmissions can be a quality issue and a financial burden. The Center for Medicare and Medicaid (CMS) has imposed hospital penalties for high readmission rates. The objective of this project was to reduce potentially preventable readmissions at Pali Momi Medical Center (PMMC) to a rate of 0.9 using the 3M Potentially Preventable Readmission methodology by December 2013. Methods: A literature search demonstrated implementing several interventions can reduce readmissions. The six interventions included the use of transitional care programs, home visits, discharge planning, medication reconciliation, post discharge phone calls, and follow-up appointments. These six interventions were implemented at PMMC using the Iowa model as a guide for implementing evidence--based practice changes. The predictive model, LACE (Length of stay, Acuity on admission, Comorbidities, and Emergency department visits), was used to assess patients at high risk for readmissions. . Outcomes: Readmission rates dropped from 1.11 to 1.05 during the first 11 months of the 12-month project using the six interventions. One of the planned interventions, using a health navigator to provide home support, was not initiated until the ninth month. Additional time is needed to see the full effects of this intervention. Conclusion: The reduction in readmission rate, although not yet at goal, did lead to a noteworthy financial benefit. PMMC experience a 38% reduction in penalties from CMS and improved reimbursement by 25% using a pay-for-performance measure from a private insurer. More work is needed to involve the community in meeting the challenges of access to care.